The
Post (Publication of the Parent Network for the Post-Institutionalized
Child), Vol. 10, pp. 3-4.

Boris Gindis, Ph.D., NYS Licensed
Psychologist

About six years ago I was consulted regarding a recently
adopted 6-year-old boy from the former Soviet Union. His medical
record included "oligophrenia" resulting in "significant
delays in psychological and language development". My findings
were that the boy was a basically normal child (with some relatively
mild and correctable weakness in language and grapho-motor skills)
and by no means fitting the image of a developmentally delayed/mentally
retarded person. His adoptive parents, who also perceived the boy
as non-handicapped, asked for an independent psychoeducational assessment
of the child "just to be sure". The parents explained
to me that physical or mental handicaps must be indicated in the
children’s medical documentation as a precondition of their adoption
by foreigners - that was a Russian law at the time! It was my first
personal experience with the confusion about psychological diagnoses
in medical documentation from Russia.

The question that arises for many actual and prospective
adoptive parents is: to what degree Russian diagnoses can be trusted
in the medical documentation of the adopted or referred children.
I would like to discuss just one such diagnosis, "oligophrenia".
First, I will describe the procedure for arriving at this diagnosis
as it "should be", that is how it appears in Russian medical
and psychological manuals and textbooks.

The term "oligophrenia" (congenital mental retardation)
is described as an impairment of all cognitive functions, without
a progressive course, due to pervasive organic injury of the hemispheric
structure Severity levels are: debils (mild retardation), imbecils
(moderate), and idiots (profound). There is a further classification
into excitable and inhibited types (V. Davydov, at al, Eds., Desk
Reference Dictionary for Psychologists, Moscow, 1983, pp. 231-232).

Identification of children with mental retardation
in Russia is different in many ways from that in the United States.
The basic methods are medical examinations and observations of "meaningful"
activities (e. g,: play, peer interaction, learning). The medical
examination is provided by a pediatrician often with a consultation
of a neurologist or other relevant medical specialists. The observation
is provided by a "defectologist" who is a special education
teacher with some background in school psychology and abnormal psychology.
Observation is based on the empirically constructed "Programs
of development" (for each year of life). These are basically
expectations of what an average child should be capable of doing
at each age level. These programs are very much akin to the Brigance
Diagnostic Inventory of Early Child Development widely used in this
country. In some cases with older children (6 years and up) the
child's cognitive development may be evaluated by using methods
closely resembling those called "dynamic assessment" in the USA.
These measurements may appear similar to our tests (e.g.: Matrices
or Block Design), but they are not standardized and during an evaluation
the stress is placed on certain qualitative indicators, such as
cognitive strategies employed by the child, type and character of
mistakes, ability to benefit from the help provided by the examiner,
and emotional reactions to success and failure. Results of these
evaluations are not expressed in numbers, but in a description of
functioning. No IQ tests are used in the identification of different
levels of mental retardation. On some occasions a clinical psychologist
may be asked to contribute. However, unlike in American practice,
a psychological evaluation in Russia is considered to be an auxiliary
to a general medico-pedagogical procedure and no more than a means
of differential diagnosis in some questionable cases. The use of
exclusively qualitative criteria makes evaluation from an American
point of view rather vague, and allows for subjective interpretation.

Results of the evaluations are summarized in a report
usually composed and signed by a medical doctor, who is considered
to be the leading specialist. A report usually contains a summary
of a child’s developmental history ("istoria razvitia rebenka").
In this history, previous examinations are cited along with examples
of primary developmental delays (that is, organically-based abnormalities)
and secondary developmental delays (social and learning problems)
in comparison with an average peer. All histories start with birth-related
data (e.g. Apgar score) and/or status at the time of leaving the
birth ward. It is to be noted that the diagnosis of oligophrenia
is never done at birth (even in the case of Down’s Syndrome). It
is rarely done earlier than 18 months of age. If there are alarming
indications of brain malfunctioning (e.g. dysmorphic features of
the body, sluggish reflexes, Apgar score below 6, etc.), another
label is usually given, namely, perinatal encephalopathy, which
is, indeed, a catchall term describing a general weakness of the
central nervous system. (Sometimes a similar diagnosis infantile
cerebral paralysis, is given). Even later in life the diagnosis
of oligophrenia is not given easily, at least according to a textbook
published in 1986 (B.V. Zeigarnik, Abnormal Psychology, Moscow,
MGU Publisher). In a situation where organically-based impairment
is not evident, but the child demonstrates either global (undifferentiated)
developmental delay or a domain-specific (e.g. language) delay,
professionals in Russia tend to use the term developmentally backward
children, general developmental delay, or delays in psychological
and language development rather than oligophrenia.

What I described above is the ideal procedure of
arriving at a diagnosis, given by a team of professionals on the
basis of different qualitative exams and observations. In real life,
I understand, there are significant deviations from this standard
routine due a shortage of staff, work overload, unscrupulous practices,
prejudices, or direct falsification, as in the case mentioned above.
In my opinion, this is the main source of misdiagnosis, not the
procedure itself. Of course, there is a subjective element in the
processes of evaluation described above which may lead to "false
positives", but the same may be found in the so-called "standardized"
assessment done in the US. I have heard from more than one adoptive
parent that their children diagnosed with oligophrenia are doing
well and are even bright. I also came across such a situation as
in the case mentioned above. On the other hand, in most of the cases
I was personally consulted on, oligophrenia was confirmed as either
mental retardation or severe learning disability. The bottom line
is that this diagnosis should be taken seriously, but not as the
final say.

For
those seeking more information on the subject of "oligophrenia"
I would recommend the following publications: